A new combination technique of the modified Robicsek wire fi
A 40-year-old man in a traffic accident was transported to our hospital. He was in a state of shock due to multiple trauma. The anatomical severity according to the Injury Severity Score was 26 points; the physiological severity according to the Revised Trauma Score was 7.10; and the probability of survival according to the Trauma and Injury Severity Score calculated from these values was 95.8%. Bone computed tomography (CT) showed a highly displaced transverse sternal fracture and rib fracture. Paradoxical breathing, i.e., flail chest, became apparent with spontaneous breathing and tachypnea and hypercapnia made withdrawal of the ventilator impossible. A transverse sternal fracture with flail chest indicated surgical repair to withdraw ventilator support.

On the 5th day after the injury, performed surgical repositioning and fixation of the sternum using the modified Robicsek technique combined with SternaLock® (Zimmer Biomet, Jacksonville, FL, US) plate fixation as described in the “Operative technique” section below. There was minimal blood loss. Due to the repositioning and stabilization of the sternal fracture, flail chest entirely disappeared, and the ventilator was successfully removed the day after the operation. A postoperative CT scan confirmed that the sternum was properly repositioned . Currently, 1.5 years have passed since the operation, and excellent fixation is still maintained.